Rx Democracy: Increasing the civic capacity of teaching hospitals to advocate with patients

Background: Academic medical centers (AMCs) and teaching hospitals disproportionately care for low-income, minority, and uninsured Americans who experience health and civic disparities. Low-income families, for instance, vote half as often and are up to six times less politically active compared with higher-income families. These same groups bear an unequal burden of disease, which exacerbates civic disparities. In 2008, illness or disability prevented 1 in 5 low-income eligible voters from voting, compared to 1 in 14 higher-income eligible voters. These civic disparities contribute to health policy inequities. For instance, legislators in the 107th and 108th Congress were three times more responsive to high-income constituents than middle-income constituents and were least responsive to low-income constituents.

Compared to other civic institutions, AMCs have been underutilized as a means of increasing civic engagement among patients, particularly in marginalized communities. Weak relationships between lay civic groups and health care institutions diminish the effectiveness of health advocacy. Few models for civic engagement among AMCs and teaching hospitals have been developed.

Methods: In 2008, a national nonpartisan coalition of health care groups was formed to increase civic participation in clinical settings, particularly among marginalized communities. In early 2011, this network launched a campaign to educate and help stakeholders in AMCs to increase capacity for health advocacy and opportunities for nonpartisan voter and civic engagement. Programs in California, Texas, New York, Massachusetts, and Washington, DC pair nonpartisan civic allies such as county election officials and the League of Women Voters with AMCs to improve capacity for civic engagement and health advocacy.

Results: Eleven nonpartisan health care organizations registered over 26,000 voters in over 200 clinical sites nationwide in 2008. The network now includes eighteen national and regional health and civic organizations and nine academic medical centers. Participating organizations indicate an increased capacity for nonpartisan civic and voter engagement, increased awareness of challenges facing health care among civic groups, and strengthened relationships between participating AMCs and lay civic groups. A majority believe increased capacity of AMCs to provide civic opportunities and to engage with lay civic groups can help address local determinants of health. Challenges include perceived cultural and institutional barriers to nonpartisan civic engagement in health care settings.

Conclusions: Nonpartisan voter and civic engagement in academic medical centers represents a novel method to partner with lay civic groups and government agencies and to dramatically improve civic agency and health advocacy for underserved populations.